Aetna Members With ACA Plans Will Need New Coverage in 2026; CVS to Exit ACA Marketplace

CVS announced today that it would be withdrawing from the Affordable Care Act (ACA) individual exchange business in 2026, which would leave 1 million people in 17 states in the US without health insurance come next year.1,2

This is not an unprecedented move for the company, according to the Wall Street Journal. Aetna had first withdrawn from the ACA in 2017 and 2018 before its return in 2021. For this iteration of the withdrawal, the loss of money surrounding the provision of Aetna and the company’s claim to focus the portfolio of the company as it turns to a new deal with Novo Nordisk to sell semaglutide for weight loss (Wegovy) for a cash price.

The move also aligns with the scheduled end of tax credits for ACA premiums that were implemented during the Biden administration and are less likely to be extended with a Republican majority in the House. Temporary subsidies were also passed in 2021 under the Biden administration and extended in 2022 to provide financial help to those who needed assistance as they enrolled in the ACA. With both of these set to expire next year, individuals who bought coverage through the ACA may face increased premiums. This led to 23.6 million individuals enrolling in the ACA just this past year, a record high for enrollment.3

Individuals receiving Aetna coverage through the ACA will need to apply for different insurance this fall | Image credit: Annap - stock.adobe.com

Aetna health insurance is only a small amount of the total medical membership that CVS reported in 2025, according to Forbes,1 and Aetna is not a major player in the ACA compared with some other health insurance options. However, the next enrollment period in fall of 2025 will require that all individuals enrolled in Aetna purchase other types of health insurance as benefits are unveiled.1 This could leave individuals with less coverage or different coverage than they are used to or that they require.

The 1 million individuals are also spread throughout 17 states, which could impact the health systems across all the states as people may be required to change providers under new coverage. With other cuts to the ACA carried out by the Trump administration, including funding for patient navigators,4 the compounding effect could leave many in the dark when it comes to picking new insurance.

“The company is best able to serve members through its other health benefit solutions, which offer access to quality care, affordable health benefits and exceptional service. The company will continue delivering superior service and support to its individual exchange members through 2025 and residual activities in 2026,” CVS said in a statement reporting on its first quarter results from 2025.5

CVS also announced that it would be selling Wegovy in its retail stores at a discounted cash price with a new deal struck with Novo Nordisk, which would allow for individuals to pay $499 per month to receive the drug and pay for it out of pocket.2 This deal was made in an effort to increase accessibility to Wegovy as compounding pharmacies lose access to the drug.

References

1. Japsen B. CVS plans to exit Obamacare in 2026, impacting 1 million Aetna members. Forbes. May 1, 2025. Accessed May 1, 2025. https://www.forbes.com/sites/brucejapsen/2025/05/01/cvs-plans-to-exit-obamacare-in-2026-impacting-1-million-aetna-members/
2. Mathews AW. CVS beats Wall Street expectations, plans to withdraw from ACA business. The Wall Street Journal. May 1, 2025. Accessed May 1, 2025. https://www.wsj.com/business/earnings/cvs-health-cvs-q1-earnings-report-2025-3f9621e5
3. Steinzor P. 24 million consumers choose ACA coverage, enrollment still open. AJMC®. January 8, 2025. Accessed May 1, 2025. https://www.ajmc.com/view/24-million-consumers-choose-aca-coverage-enrollment-still-open
4. Weiland N. Trump shrinks funds for navigators who help Americans enroll in Obamacare. The New York Times. February 14, 2025. Accessed May 1, 2025. https://www.nytimes.com/2025/02/14/us/politics/trump-obamacare-navigators.html
5. CVS Health Corporation reports first quarter 2025 results and updates full-year 2025 guidance. News release. CVS Health; May 1, 2025. Accessed May 1, 2025. https://www.prnewswire.com/news-releases/cvs-health-corporation-reports-first-quarter-2025-results-and-updates-full-year-2025-guidance-302443511.html